Continuous hydromorphone for pain and sedation in mechanically ventilated infants and children

Abstract

To describe dosing regimens and efficacy of continuous infusion hydromorphone in mechanically ventilated children. Retrospective review. Tertiary care, pediatric hospital. Ninety-two critically ill children (<18 years old). Hydromorphone dosing requirements, concomitant pain and sedation therapy, patient-specific pain scores (using Face Legs Activity Cry Consolability [FLACC] pain scale), and possible adverse drug events related to therapy. Starting dose was 0.024 +/- 0.04 mg/kg/h. Maximum dose was 0.05 + 0.1 mg/kg/h. Duration of therapy was 182 +/- 169 hours. Most patients received additional pain and sedation therapy. Most mean daily FLACC scores (66 percent) were below 1. Less than 10 percent of scores were above 3; only 1 score was above 6. Mean FLACC score, when averaged per patient course, was 1.004 +/- 0.71. Extracorporeal membrane oxygenation (ECMO) patients had a significantly higher initial and maximum dosing requirement than non-ECMO patients (p = 0.001). Continuous infusion hydromorphone appears to be an effective adjunctive analgesic in mechanically ventilated children.